目的:评估尿酸(UA),高血压患者的24小时微量白蛋白(24h-MAU)和估计的肾小球滤过率(eGFR)。
方法:本研究招募了在泰达国际心血管病医院住院的成年患者。本研究用于探讨UA,24h-MAU和eGFR。单变量分析用于根据数据类型比较连续或分类数据组。采用多因素分析探讨UA、通过线性回归记录24h-MAU和eGFR,以及UA之间的关系,通过逻辑回归分析,24h-MAU≥30mg/24h(24h-MAU增加)和eGFR<90ml·min-1·1.73m-2(eGFR轻度降低)。采用中介效应分析探讨24h-MAU升高在UA和eGFR轻度降低之间的中介效应。采用亚组分析探讨UA、24h-MAU和eGFR在不同性别。
结果:733名住院患者被纳入研究,包括257名高尿酸血症患者。所有入组患者UA水平为377.8±99.9μmol/L,高尿酸血症组高约50.1%(482.3±58.8μmol/Lvs.321.4±63.5μmol/L,P<0.001)。高尿酸血症的患病率为35.1%(95CI31.6-38.5%)。单因素回归分析显示UA与Log24h-MAU显著相关,增加24h-MAU,eGFR和轻度降低eGFR。在调整了混杂因素后,UA与Log24h-MAU显著相关(β=0.163,P<0.001),eGFR(β=-0.196,P<0.001),24h-MAU增加(定量分析:OR=1.045,95CI1.020-1.071,P<0.001;定性分析:OR=2.245,95CI1.410-3.572,P=0.001),但与eGFR轻度下降没有显著关系。中介效应分析表明,24h-MAU升高部分介导了UA与eGFR轻度降低之间的关系(相对间接效应:定量分析和定性分析分别为25.0%和20.3%)。在亚组分析中,结果稳定,与入组患者的分析相似.
结论:高血压住院患者高尿酸血症的患病率较高。UA与Log24h-MAU密切相关,eGFR和增加24h-MAU,而eGFR轻度下降的相关性受多种因素影响。24h-MAU增加可能是UA和eGFR轻度降低之间的中间因素。
To estimate the relationship among uric acid (UA), 24-h microalbumin (24 h-MAU) and estimated glomerular filtration rate (eGFR) in hypertensive patients.
The study enrolled adult patients hospitalized in TEDA International Cardiovascular Hospital. The study was used to explore the correlation among UA, 24 h-MAU and eGFR. Univariate analysis was used to compare continuous or categorical data groups according to data type. Multivariate analysis was used to explore the correlation among UA, Log 24 h-MAU and eGFR by linear regression, and the relationship among UA, 24 h-MAU ≥ 30 mg/24 h (increased 24 h-MAU) and eGFR < 90 ml·min-1·1.73 m-2 (mildly decreased eGFR) by logistic regression. Mediation effect analysis was used to explore the mediating effect of increased 24 h-MAU between UA and mildly decreased eGFR. Subgroup analysis was used to investigate the correlation among UA, 24 h-MAU and eGFR in different gender.
Seven hundred and thirty-three inpatients were enrolled in the study, including 257 patients with hyperuricemia. The level of UA was 377.8 ± 99.9 μmol/L in all patients enrolled, and it was about 50.1% higher in hyperuricemia group (482.3 ± 58.8 μmol/L vs. 321.4 ± 63.5 μmol/L, P < 0.001). The prevalence of hyperuricemia was 35.1% (95%CI 31.6-38.5%). The univariate regression analysis showed that UA was significant related to Log 24 h-MAU, increased 24 h-MAU, eGFR and mildly decreased eGFR. After adjusted confounding factors, UA was significant related to Log 24 h-MAU (β = 0.163, P < 0.001), eGFR (β = - 0.196, P < 0.001), increased 24 h-MAU (quantitative analysis: OR = 1.045, 95%CI 1.020-1.071, P < 0.001; qualitative analysis: OR = 2.245, 95%CI 1.410-3.572, P = 0.001), but had no significant relationship with mildly decreased eGFR. Mediating effect analysis showed that increased 24 h-MAU partially mediated the relationship between UA and mildly decreased eGFR (relative indirect effect: 25.0% and 20.3% in quantitative analysis and qualitative analysis respectively). In the subgroup analysis, the results were stable and similar to the analysis for entry patients.
The prevalence of hyperuricemia was higher in hypertensive inpatients. UA was strongly associated with Log 24 h-MAU, eGFR and increased 24 h-MAU, while the correlation with mildly decreased eGFR was affected by multiple factors. And increased 24 h-MAU might be the intermediate factor between UA and mildly decreased eGFR.